Is this the ideal case for immediate implant placement?

I think immediate Implant with small size indicated with through curratage of granulation tissue is ok 47should be placed in distal socket .

I definitely would not ....... interesting to see a full mouth view ...... an Implant case maybe not very poor dentition . Peter

I agree with Peter, need to see full mouth. immediate implants in this case would be very technique sensitive... why take the risk. In my opinion, "Ideal" immediate implants are done in the absence of infection. Sometimes these abscesses are easy to curettage but many times they turn in the bone where you can't get access to remove them completely. Socket preservation and second stage implant placement look to be the most appropriate solution.

A lot of bacteria in there!

Little PA R/L seen in 2nd molar only and the 1st molar mesial root. Lasers can work well if planning Immediate implants and obviously if patient general health Ok.Postop Good Antibiotics. You can take immediate tissue culture after extraction and check for antibiotic senstivity if you have good pathology lab support. Good Luc😊

I'm still new with placing/restoring implants and ridge preservation/bone grafting procedures, but your question is this ideal for immediate implant placement? I'm pretty confident that most commenters here would say no and I would agree. I thought for immediate implants you need the following 1) lack of infection/pap, 2) single root teeth, and 3) healthy gingival tissues/biotype to consider an immediate. Is my thinking off or dated here? Thanks, Justin

Any history of etiology in this case, I would be suspicious of acid erosion due to bulimia, or meth use. These teeth look like they are eroded and or decayed. A lot of widespread damage in a 22 year old female patient. At the very least will this patient be able to assume hygiene responsibility. I would be cautious and get the whole story. This is not a good choice for an immediate case until the whole story is known and patient can maintain oral hygiene.

Many good answers.... The simple answer to the posed question, is this an ideal immediate implant placement case? NO

Only one xray provided, no panorex or scan, no photographs........phew!!!! From the information provided, the patient is only 22 years old, and look at the destruction!! If you want to repair the bone and graft...this is fine...but certainly no implants at this stage, this person has to learn how to appreciate fine dentistry, and make a commitment to change his/her oral hygiene and habits. Gerry Rudick Montreal, Canada

As many have previously noted, it is really impossible to make any reasonable opinion with this limited information. Certainly there is major pathology related to the erosion ? decay and endodontics that is exhibited here. Before considering any implants the etiology of this situation needs to be determined and a comprehensive treatment plan needs to be discussed. However I am commenting here because I see so much negativity to the placement of immediate implants. I place immediate implants quite frequently. I have been placing implants since 1986(I am a Prosthodontist and at that time I had to hide this from the surgeons or they would not refer to me!) and I have had minimal problems with placement at the time of extraction. Most of my immediate implants have some pathology associated with them and certainly many are of multiple rooted teeth. Evaluation of a CBCT scan is crucial and the times I cannot do immediate implants is usually not because of infection or pathology but because I have anatomic limitations like the inferior alveolar nerve or the sinus where I cannot obtain enough stability for the new implant. However this is fairly infrequently. I find fresh extraction sites to often be the ideal time for an implant because you know exactly where you want to be and with multiple sizes of implants in both width and length I can usually get excellent primary stability. I do thoroughly currette out the socket, then I use a surgical round bur and finally I use an Erbium:Yag laser with water and at a low setting(85mj and 10 hz). I also place temporary crowns on anterior teeth and premolars if I get over 35 ncm of retention. I do relieve the bite particularly in lateral excursions. For the molar areas I usually place a custom healing cuff that maintains the papilla and buccal and lingual walls by using a composite to titanium screw that is custom made to the socket shape. Then I use that to make my custom impression post and the implants look like real teeth. Obviously this opinion is different than many of the previous ones. That is what I really enjoy about dentistry. There is more than one way to do everything that we do! If anyone has any questions you are welcome to contact me at TucsonSmile.com

Dear Dentist, A 22 year old is pretty young to be yanking out the teeth. It might be a good idea to try to save all of them via root canal, posts, and splinting them together with crowns. Try using the SWEAR Chart to determine whether the teeth should be Saved, Waited on for a while, Extracted and implanted, And......... maybe Referred.. Try this link to look at the SWEAR Chart: http://smalldentalimplants.blogspot.com/p/the-leaning-tower-of-pisa-and-diseased.html Regards.

Apart from the the obvious decay issues the patient seems to have a lot of tooth surface loss, also the type of loss (cupping loss on occlusal surfaces with sharp lips pf enamel) may indicate a reflux issue or similar pathology. Have you got enough inter-occlusal space to place a crown of thr proper dimensions and anatomy on any proposed implant? Have you got a diagnostic wax-up?

As individual sites, I see no problem with placing immediate Bicon Short implants with bone grafting and, perhaps Guided Bone Regeneration on the second molar. I try to wedge the Bicon impact bodies in the septal bone by first clipping with Ronguers and the using some sized expansion plugs to shape a "nest" to firmly hold it in place. Bicons are "press It" devices and very little pressure is needed. The valid concern over placing implants in these situations is dual sourced Patients: who are not accustomed to the necessary routine care and the imperfections, possible "hitches", in any treatment process, can be very upset if their expectations are not met. Negative Results: Infections, bone health, hygiene, and general healing capability. However, the reparative juices are high at the time of extraction, and if infection control can be established at extraction, the success rate is high. Esthetic areas are complicated by uncertainty of he final bone/tissue areas, but a posterior submerged design like Bicon allows a range of acceptable levels posteriorly. With antibiotic pre-Med, and though socket cleaning/rinsing with sterile water, most of the bugs can be controlled with minimal bone or graft interference. The "At Worst" scenario needs consideration: how difficult would it be to remove the implant/graft if serious infection arises? The press fit Bicons are no problem, but I've only had to remove one immediate Bicon in several decades. And short is better when an infection rages around an implant.

I do concur that a full set of records, diagnosis, consultation, and comprehensive treatment plan is critical.

It depends on your level of experience. It is not easy but can be done as long as the bone is not compromised and you have enough bone to stabilize the implant. You don't need anything fancy to degranulate the site and decontaminated. Peridex or tetracycline flush would it. I also recommend antibiotics starting before the surgery.

I would be for to your level of expertise and experience. I would definitely try immediate implant placement post extraction. I agreed that the fresh extraction socket is the ideal condition for Osseo integration of Implants. There is a novel technique called the anatomical guide. This requires you to dress down the crown until you get to the bifurcation. Then you would place your initial number or are you Lancette burger in the middle of the two roots. I usually instrument a 2.3 twist drill to depth prior to atraumatically removing the roots. What's left is a centered site for continued drill sequencing. It takes practice of course. Good luck

Dr.K.F. Chow 's recommendations are good.Follow conservative approach. What Devan's dictum says?

The underpinning essential concept demanding “immediate placement” is that it avoids the horrors of a partial denture or missing teeth. The risk weighed against the benefit. The horror of waiting verses the adulation of sudden teeth? There is no downside to removal of those harbingers of infection: no smile with gaps, no eating or phonetic disadvantage. To remove these bubbling brooks of infection so to allow healing and reflection is grand. To place implants into fresh sockets is noble but one needs a NEED. That risky early intervention solves a later problem. There is no clinical or aesthetic imperative to implant quickly in the posterior of the mandible. Additionally, the diameter of an implant should be close to the socket diameter. A molar alveolar gap of 6 mm may not retain its blood clot, whereas a 4.3 implant in a 5 mm socket crest has a more rapid infill time frame.

No